The Bethesda systemThe Bethesda system for reporting thyroidfor reporting thyroid

cytopathologycytopathology

Mansour Mehzad, MD, FIACMansour Mehzad, MD, FIAC

The Bethesda system for reporting thyroid cytopathology I. Non-diagnostic or Unsatisfactory - Cyst fluid only ( macrophages only ) - Virtually acellular specimen - Other (obscuring blood, clotting artefact,etc)

II. Benign - Consistent with a benign follicular nodule ( includes adenomatous nodule,colloid nodule) - Consistent with lymphocytic (Hashimoto’s) thyroiditis in the proper clinical context - Consistent with granulomatous (subacute) thyroiditis - Other

III. Atypia of undetermined significance or follicular lesion of undetermined significance

IV. Follicular neoplasm or suspicious for a follicular neoplasm - Specify if Hurthle cell (oncocytic) type

V. Suspicious for malignancy - Suspicious for papillary carcinoma - Suspicious for medullary carcinoma - Suspicious for metastatic carcinoma - Suspicious for lymphoma - Other

VI. Malignant - Papillary carcinoma - Poorly differentiated carcinoma - Medullary thyroid carcinoma - Undifferentiated (anaplastic) carcinoma - Squamous cell carcinoma - Carcinoma with mixed features (specify) - Metastatic carcinoma - Non-Hodgkin’s lymphoma - Other

Macrophages only

Adenomatous nodule

Adenomatous nodule

Colloid nodule

Focal hurthle cell metaplasia in goiter

Hashimoto’s thyroiditis

Subacute thyroiditis

Radioactive iodine effect

Follicular neoplasm

Follicular neoplasm,trabecular type

Hurthle cell neoplasm

Papillary carcinoma

Papillary carcinoma

Papillary carcinoma,follicular variant, Giemsa stain

Papillary carcinoma,follicular variant , Pap.stain

Poorly differentiated carcinoma

Medullary carcinoma, Pap stain

Medullary carcinoma, Giemsa stain

Medullary carcinoma, immunoreactive for calcitonin

Anaplastic carcinoma

Squamous cell carcinoma

Metastatic renal cell carcinoma

MALT lymphoma

ReferencesReferences: : 11 . .National Cancer Institute (NCI), Thyroid Fine needleNational Cancer Institute (NCI), Thyroid Fine needle

aspiration state of the science, conference in 2007aspiration state of the science, conference in 2007 . .

22 . .Edmond S. Cibas, Barbara S. Ducathman. CYTOLOGYEdmond S. Cibas, Barbara S. Ducathman. CYTOLOGY , ,

diagnostic principles and clinical correlates, saundersdiagnostic principles and clinical correlates, saunders , ,

33rd rd edition,2009edition,2009..

33 . .Marluce Bibbo, Acta Cytologica, volume 53, 489-490, 2009Marluce Bibbo, Acta Cytologica, volume 53, 489-490, 2009

For more study on cytopathology of For more study on cytopathology of the thyroid gland refer to the CD inthe thyroid gland refer to the CD in

this subject prepared by the Societythis subject prepared by the Society . .

The Members may call for a free copyThe Members may call for a free copy

from ISCC office in Isfahanfrom ISCC office in Isfahan . .